Immunization Action Coalition and the Hepatitis B Coalition

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Issue Number 460            May 17, 2004

CONTENTS OF THIS ISSUE

  1. May 2004 issue of "NEEDLE TIPS" provides up-to-date resources on childhood, adolescent, and adult immunization
  2. CDC reports on a varicella outbreak among vaccinated children at a Michigan elementary school in 2003
  3. WHO pulls together a partnership to contain outbreak of meningococcal disease in Burkina Faso

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ABBREVIATIONS: AAFP, American Academy of Family Physicians; AAP, American Academy of Pediatrics; ACIP, Advisory Committee on Immunization Practices; CDC, Centers for Disease Control and Prevention; FDA, Food and Drug Administration; IAC, Immunization Action Coalition; MMWR, Morbidity and Mortality Weekly Report; NIP, National Immunization Program; VIS, Vaccine Information Statement; VPD, vaccine-preventable disease; WHO, World Health Organization.
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May 17, 2004
MAY 2004 ISSUE OF "NEEDLE TIPS" PROVIDES UP-TO-DATE RESOURCES ON CHILDHOOD, ADOLESCENT, AND ADULT IMMUNIZATION

IAC recently mailed the latest issue of "NEEDLE TIPS" to 100,000 health professionals and others who work in the field of immunization. Packed with timely immunization resources for health professionals, patients, and parents, the 24-page issue is well worth downloading. All articles and education pieces, except editorials, have been thoroughly reviewed by immunization and hepatitis experts at CDC.

HOW TO READ "NEEDLE TIPS" ON THE WEB
You can view selected articles from the table of contents below or download the entire issue from the Web.

To view the table of contents with links to individual articles, go to:
http://www.immunize.org/nt

Please note: The PDF file of the entire issue, linked below, is large at 999,733 bytes. Some printers cannot print such a large file. For tips on downloading and printing PDF files, go to: http://www.immunize.org/nslt.d/tips.htm

To download a ready-to-copy (PDF) version of the May issue, go to: http://www.immunize.org/nslt.d/n30/n30.pdf

The articles in the May issue fall into three broad areas: (1) general immunization information,(2) childhood and adolescent immunization resources, and (3) adult immunization resources.

(1) GENERAL IMMUNIZATION INFORMATION
Turn to the following resources for the latest information on immunization.

  • ANSWERS TO PROFESSIONALS' QUESTIONS, CURRENT VACCINE NEWS, AND CURRENT VACCINE DISTRIBUTION INFORMATION. "Ask the Experts" answers questions about immunization and viral hepatitis. "Vaccine Highlights" presents timely information on recommendations, schedules, specific vaccines, and vaccine safety. Updated in March, "Vaccines and Related Products Distributed in the United States, 2004" is an exhaustive listing of vaccines and biologics with information about brand names, manufacturers' telephone numbers and web addresses, and more.
     
    To access a ready-to-copy (PDF) version of "Ask the Experts," go to: http://www.immunize.org/nslt.d/n30/expert30.pdf

    To access a web-text (HTML) version, go to:
    http://www.immunize.org/nslt.d/n30/expert30.htm
     
    To access a ready-to-copy (PDF) version of "Vaccine Highlights," go to:
    http://www.immunize.org/nslt.d/n30/vaccin30.pdf
     
    To access a web-text (HTML) version, go to:
    http://www.immunize.org/nslt.d/n30/vaccin30.htm

    To access a ready-to-copy (PDF) version of "Vaccines and Related Products Distributed in the United States, 2004," go to:
    http://www.immunize.org/catg.d/2019prod.pdf

    No web-text (HTML) version is available.

(2) CHILDHOOD AND ADOLESCENT IMMUNIZATION RESOURCES
The following five articles will be particularly useful to medical professionals who see pediatric patients.

  • VACCINE SAFETY ARTICLES. Increasingly, as parents turn to the mass media and Internet for health information, health professionals are called on to counter misinformation, educate about immunization, and help parents evaluate mass media and Internet sources. Two articles, "Communicating with Families About Vaccines" and "Does MMR Vaccine Cause Autism? Examine the Evidence!" give health professionals powerful tools for speaking with parents who have doubts about vaccinating their children.
     
    To access a ready-to-copy (PDF) version of "Communicating with Families About Vaccines," go to:
    http://www.immunize.org/nslt.d/n30/vaxandfamilies.pdf

    No web-text (HTML) version is available.
     
    To access a ready-to-copy (PDF) version of "Does MMR Vaccine Cause Autism? Examine the Evidence!" go to:
    http://www.immunize.org/catg.d/p4026.pdf
     
    To access a web-text (HTML) version, go to:
    http://www.immunize.org/mmrautism
     
  • IMMUNIZATION ASSESSMENT AND SCHEDULING RESOURCES. A parent's answers to "Screening Questionnaire for Child and Teen Immunization" will give health professionals the information they need to assess whether the child has any contraindications to vaccination on the day of the visit. Based on resources from CDC, "When Do Children and Teens Need Vaccinations?" and "Summary of Rules for Childhood and Adolescent Immunization" present in chart form the schedule and recommendations for vaccines commonly given to children and teens.
     
    To access a ready-to-copy (PDF) version of "Screening Questionnaire for Child and Teen Immunization" go to:
    http://www.immunize.org/catg.d/p4060scr.pdf
     
    To access a web-text (HTML) version, go to:
    http://www.immunize.org/catg.d/p4060scr.htm
     
    To access a ready-to-copy (PDF) version of "When Do Children and Teens Need Vaccinations?" go to:
    http://www.immunize.org/catg.d/when1.pdf
     
    To access a web-text (HTML) version, go to:
    http://www.immunize.org/nslt.d/n17/when1.htm

    To access a ready-to-copy (PDF) version of "Summary of Rules for Childhood and Adolescent Immunization" go to:
    http://www.immunize.org/catg.d/rules1.pdf

    To access a web-text (HTML) version, go to:
    http://www.immunize.org/nslt.d/n17/rules1.htm

(3) ADULT IMMUNIZATION RESOURCES
If you provide vaccination services to adults, you'll want to use the following five resources to improve adult immunization rates in your practice:

  • INFLUENZA VACCINATION OF HEALTH CARE WORKERS. In response to the distressing statistic that only 36% of health care workers receive annual influenza vaccination, IAC developed "First Do No Harm. Protect Your Patients by Getting Vaccinated Against Influenza," a one-page professional-education sheet that outlines the primary steps necessary to conduct an employee influenza immunization campaign for health care workers.
     
    To access a ready-to-copy (PDF) version of "First Do No Harm. Protect Your Patients by Getting Vaccinated Against Influenza" go to:
    http://www.immunize.org/catg.d/p2014.pdf
     
    To access a web-text (HTML) version, go to:
    http://www.immunize.org/catg.d/p2014.htm
     
  • STANDING ORDERS PROTOCOL. "Standing Orders for Administering Pneumococcal Vaccine to Adults" gives health professionals a guideline that can be used to allow an appropriately licensed individual to administer pneumococcal polysaccharide vaccine without a direct order from a physician.
     
    To access a ready-to-copy (PDF) version of "Standing Orders for Administering Pneumococcal Vaccine to Adults," go to:
    http://www.immunize.org/catg.d/p3075.pdf
     
    No web-text (HTML) version is available.
     
  • ASSESSMENT AND PATIENT EDUCATION RESOURCES. A patient's answers to "Screening Questionnaire for Adult Immunization" will give health professionals the information they need to assess whether the patient has contraindications to vaccination on the day of the visit. "Immunization . . . Not Just Kids' Stuff" encourages patients to safeguard their health by getting vaccinated against VPDs if they haven't had certain diseases or been vaccinated against them. "Protect Yourself against Hepatitis A and Hepatitis B . . . A Guide for Gay and Bisexual Men" educates men who have sex with men about their increased risk for contracting these two diseases and makes the case for getting immunized against them. Please note that this brochure is intended for use in certain venues--STD clinics and clinics for men who have sex with men, for example. It's not suitable for the waiting rooms of most clinics and medical practices.
     
    To access a ready-to-copy (PDF) version of "Screening Questionnaire for Adult Immunization" go to:
    http://www.immunize.org/catg.d/p4065scr.pdf
     
    To access a web-text (HTML) version, go to:
    http://www.immunize.org/catg.d/p4065scr.htm

    To access a ready-to-copy (PDF) version of "Immunization . . . Not Just Kids' Stuff," go to:
    http://www.immunize.org/catg.d/p4035.pdf

    To access a web-text (HTML) version, go to:
    http://www.immunize.org/nslt.d/n17/p4035.htm

    To access a ready-to-copy (PDF) version of "Protect Yourself against Hepatitis A and Hepatitis B . . . A Guide for Gay and Bisexual Men" go to:
    http://www.immunize.org/catg.d/p4115.pdf

    To access a web-text (HTML) version, go to:
    http://www.immunize.org/catg.d/p4115.htm

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May 17, 2004
CDC REPORTS ON A VARICELLA OUTBREAK AMONG VACCINATED CHILDREN AT A MICHIGAN ELEMENTARY SCHOOL IN 2003

CDC published "Outbreak of Varicella Among Vaccinated Children--Michigan, 2003" in the May 14 issue of MMWR. Portions of the article are reprinted below.

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On November 18, 2003, the Oakland County Health Division alerted the Michigan Department of Community Health (MDCH) to a varicella (chickenpox) outbreak in a kindergarten [through] third grade elementary school. On December 11, MDCH and Oakland County public health epidemiologists, with the technical assistance of CDC, conducted a retrospective cohort study to describe the outbreak, determine varicella vaccine effectiveness (VE), and examine risk factors for breakthrough disease (i.e., varicella occurring >42 days after vaccination). This report summarizes the results of that study, which indicated that (1) transmission of varicella was sustained at the school for nearly 1 month despite high vaccination coverage, (2) vaccinated patients had substantially milder disease (<50 lesions), and (3) a period of =>4 years since vaccination was a risk factor for breakthrough disease. These findings highlight the importance of case-based reporting of varicella and the exclusion of patients from school until all lesions crust or fade away. Information about recognizing vaccinated patients with mild cases should be disseminated to health care providers, school administrators, and parents. . . .

Attack rates were 11.8% (52 of 442) for vaccinated and 76.9% (10 of 13) for unvaccinated students. VE was 84.7% (95% confidence interval [CI] = 77.4%-89.7%) in preventing varicella of any severity and 97.6% (95% CI = 95.0%-98.9%) in preventing moderate to severe varicella. Vaccinated patients were more likely to have mild disease than unvaccinated patients (84.6% versus 20.0%; p<0.01), were less likely to have fever (44.2% versus 88.9%; p<0.05), and missed fewer days of school (1.3 versus 3.5 median days; p<0.01). Children vaccinated =>4 years before the outbreak were nearly five times more likely to acquire varicella than children vaccinated within the previous 4 years (relative risk = 4.65; 95% CI = 1.48-14.61). Age at vaccination, sex, and preexisting conditions (e.g., asthma and eczema) were not associated with vaccine failure. Vaccine lot numbers were identified for 30 patients; vaccine from 26 different lot numbers was administered on multiple dates by multiple providers, indicating that breakdown in vaccine storage or handling procedures was not a likely risk factor for vaccine failure.

Editorial Note:

Varicella is a highly infectious disease that, in the prevaccine era, resulted in approximately 4 million illnesses, 11,000 hospitalizations, and 100 deaths annually in the United States. In 1995, a live, attenuated varicella vaccine was licensed for use in the United States, and the majority of studies of vaccine performance have demonstrated an overall VE of 70%-90%. Since vaccine licensure, the United States has experienced a steady decline in the incidence of varicella disease, attributed to increasing vaccination coverage. The findings in this report are consistent with those of recently published studies on VE and the association between longer time since vaccination and breakthrough disease.

Cases of mild disease, not recognized as varicella before detection of the outbreak, might have played an important role in virus transmission in this highly vaccinated population. All patients with chickenpox should be excluded from schools or day care centers until all lesions have crusted. However, breakthrough disease usually is mild and might not include vesicular lesions that crust. To help prevent disease spread in schools and day care centers, health care providers, school administration, and parents must learn to recognize students with vaccine-modified varicella and exclude them from schools until lesions fade away or no new lesions appear.

Local varicella surveillance consists of passive reporting of aggregate case counts to state health departments. Timely reporting of individual varicella cases and appropriate follow-up might have ensured exclusion of patients from school and reduced the size of this outbreak. As vaccination coverage increases, the proportion of breakthrough cases also will increase. Health departments can begin to evaluate the impact of varicella vaccination programs through case-based surveillance that collects information about age, vaccination status, and severity of disease. These data can help to detect changes in epidemiology of varicella disease over time, such as a potential shift to older age groups or changes in disease severity among breakthrough cases. The Council of State and Territorial Epidemiologists has recommended that states implement case-based surveillance of varicella by 2005.

The findings in this report indicate that varicella vaccine was effective (85%) in preventing varicella of any severity and highly effective (98%) in preventing moderate to severe disease. Although longer time since vaccination was identified as a potential risk factor for vaccine failure, prospective follow-up studies are needed to examine the importance of individual risk factors for breakthrough disease, after controlling for the effects of other factors (e.g., risk for exposure). In addition, these findings underscore the importance of continuing to increase vaccination rates nationwide, ensuring that vaccination remains the cornerstone of efforts to control varicella.

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To access a web-text (HTML) version of the complete article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5318a4.htm

To access a ready-to-copy (PDF) version of this issue of MMWR, go to: http://www.cdc.gov/mmwr/PDF/wk/mm5318.pdf

To receive a FREE electronic subscription to MMWR (which includes new ACIP statements), go to:
http://www.cdc.gov/mmwr/mmwrsubscribe.html
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May 17, 2004
WHO PULLS TOGETHER A PARTNERSHIP TO CONTAIN OUTBREAK OF MENINGOCOCCAL DISEASE IN BURKINA FASO

Earlier this year, the West African country of Burkina Faso experienced an outbreak of W135 meningitis that infected 1500 people, of whom 300 died. In comparison, during the last W135 outbreak in 2002, 13,000 people were infected and 1500 died.

According to a press release issued by WHO on April 8, the steep decline in morbidity and mortality resulted from a cooperative effort by humanitarian organizations, industry, international agencies, and lab trainers, as well as contributions from governments, organizations, and individuals.

Following the 2002 outbreak, WHO began organizing partnerships to build a mass intervention delivery system in the region. The following two paragraphs from the WHO press release explain the partnership and its accomplishments.

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Laboratory workers and field epidemiologists were trained and supplied with materials so that W135 could be rapidly detected, tracked, and confirmed. Regional monitoring was established at WHO's Subregional Multidisease Center in Ouagadougou, Burkina Faso. At the same time, pharmaceutical partner GlaxoSmithKline developed a new vaccine, which was tested and approved in record time. Following negotiations with WHO, the company priced the vaccine affordably, at one Euro a dose.

To purchase an emergency stockpile of the vaccine, WHO issued an urgent appeal last September. The reaction was rapid. Funds came in from the governments of Ireland, Italy, Monaco, and the United Kingdom, and from Medecins Sans Frontieres [Doctors Without Borders], the Norwegian Red Cross, UNICEF, and private individuals. The goal was reached, and the first doses [were] taken from the stockpile and used in Burkina Faso in [the 2004 outbreak.]

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To access the WHO press release, go to:
http://www.who.int/mediacentre/releases/2004/pr25/en/print.html

 

Immunization Action Coalition1573 Selby AvenueSt. Paul MN 55104
E-mail: admin@immunize.org Web: http://www.immunize.org/
Tel: (651) 647-9009Fax: (651) 647-9131

This page was updated on May 17, 2004